title: Autoantibodies predicting the outcome of rheumatoid arthritis: evaluation in two subsets of patients according to severity of radiographic damage.
abstract: OBJECTIVE
  Autoantibodies such as rheumatoid factor (RF), antikeratin antibodies (AKA), antiperinuclear factor (APF), and anti-RA 33 antibodies are considered of value for the diagnosis of RA. The purpose of this study was to evaluate these autoantibodies as predictors of severe radiographic damage in rheumatoid arthritis (RA).
  
  
  METHODS
  Eighty six patients with RA (70 women, 16 men) fulfilling 1987 ACR criteria were selected from a cohort of 469 patients followed up since the first year of RA onset because they could be divided in two groups according to the severity of the radiographic damage. These 86 patients had a mean (SD) disease duration of eight (four) years: 43 patients had severe radiographic damage (Larsen score > or = 2) and 43 had limited radiographic damage (Larsen score < 2). The two groups were matched by disease duration and sex. The following autoantibodies were looked for: RF, ANA, AKA, APF, and anti-RA 33 antibodies. In addition, HLA class II DR beta alleles and standard inflammatory parameters (erythrocyte sedimentation rate, C reactive protein) were determined.
  
  
  RESULTS
  Patients with severe radiographic damage differed from those with limited radiographic damage in that they had higher RF (p = 0.01), APF (p < 0.02), and AKA (p = 0.001) titres. Stepwise regression analysis was done to calculate the odds ratios (OR) for each clinical and laboratory variable; only presence of cutaneous nodules (OR: 14.9; 95% CI: 7, 128), HLA DRB1*04 or DRB1*01 (OR: 7.53; 95% CI: 1.32, 42.9), AKA (OR: 3.11; 95%, CI: 0.58, 16.8), a high erythrocyte sedimentation rate (OR: 2.66; 95% CI: 0.60, 11.9), and a high C reactive protein value (OR: 7.4; 95% CI: 1.43, 38.1) were predictive of severe radiographic damage.
  
  
  CONCLUSIONS
  These data suggest that the risk of severe radiographic damage in RA patients is higher when cutaneous nodules, HLA DRB1*04 or DRB1*01, and/or AKA are present. The other autoantibodies of diagnostic significance are of little help for predicting joint destruction.
authors.affiliation: Department of Rheumatology and Immuno-rheumatology Laboratory, Bichat Hospital, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Meyer
authors.forename: B
authors.initials: B
authors.lastname: Combe
authors.forename: A
authors.initials: A
authors.lastname: Elias
authors.forename: K
authors.initials: K
authors.lastname: Benali
authors.forename: J
authors.initials: J
authors.lastname: Clot
authors.forename: J
authors.initials: J
authors.lastname: Sany
authors.forename: J F
authors.initials: JF
authors.lastname: Eliaou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology*; D001175:Arthrography; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005069:Evaluation Studies as Topic; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D006684:HLA-DR Antigens / Q000032:analysis; D059811:HLA-DRB1 Chains; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D007633:Keratins / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012217:Rheumatoid Factor / Q000097:blood; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D015415:Biomarkers; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C030902:antiperinuclear factor; D007633:Keratins; D002097:C-Reactive Protein; D012217:Rheumatoid Factor